title: Peripheral blood progenitor cell transplantation: impact on the pharmacy workload and budget.
abstract: Due to reduced engraftment times and significantly shortened hospitalizations, peripheral blood progenitor cell (PBPC) transplantation has reduced the costs associated with autologous transplantation. Several institutions reported a reduction of 20-50% in transplantation cost using PBPCs and an aggressive outpatient program. These savings could be offset by hospital readmissions, but improvements in supportive care such as administration of colony-stimulating factors and broad-spectrum oral antibiotics, and assigning a 24-hour caregiver as a prerequisite for transplantation enable safe performance of outpatient transplantation and limit readmission rates to about 20-40%. At this institution, the effect of this program on the pharmacy has been a shift in staff and drug costs to outpatient cost centers. The transition from inpatient to outpatient care did not necessitate a greater investment in pharmacy staffing, but did require cross-training for inpatient and outpatient pharmacists. Future management of outpatient transplantation will apply a cooperative care philosophy that will rely to a large extent on patient care by family members and on a multidisciplinary model of seamless care.
authors.affiliation: Department of Pharmaceutical Services, University of Nebraska Medical Center, Omaha 68198-1090, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Davis
mesh_terms: D000553:Ambulatory Care; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006801:Humans; D009329:Nebraska; D009369:Neoplasms / Q000191:economics*; D010607:Pharmacy Service, Hospital / Q000191:economics*; D014182:Transplantation, Autologous